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In 1745, Gerhard van Swieten published, in Latin, a five volume commentary on the writings of Boerhaave1 that influenced medical practice throughout Europe. It contains the following account, considered by Isler2 to be the first description known to date of episodic cluster headache:
“A healthy, robust man of middle age was, each day, at the same hour troubled by pain above the orbit of the left eye, where the nerve leaves through the bony frontal opening; after a short time the left eye began to redden and tears to flow; then he felt as if his eye was protruding from its orbit with so much pain that he became mad. After a few hours all this evil ceased and nothing in the eye appeared at all changed.
I ordered blood to be let, gave antiphlogistic purgatives, I frequently applied cupping to the neck, vesicant adhesives etc but all in vain. But in order to understand this miraculous illness, I went to him at the time when he knew the pain would return, and I saw all the symptoms he remembered; in the carpal pulse however I found nothing changed. The patient reminded me, whilst I sat with him, that in the medial canthus of the eye he felt a large pulsation: I applied the apex of my little finger to the artery, which goes around the medial canthus of the eye, then with the other hand explored the carpal pulse; and thus I manifestly perceived how the artery in the canthus of the eye was pulsing more rapidly, and strongly than it naturally does.
I therefore believed that there was a fever, but a topical one; and I gave Peruvian bark and with luck cured it; and from this case I later learned to use similar remedies.”
“The Peruvian bark which has so much use in strengthening the nervous system and in realigning the disordered moving spirits, overwhelms any species of intermittent fever without making any evident evacuations…”
Isler notes gratuitously that the description conforms to the International Headache Society criteria of 1988. Early accounts of Willis (1672) and Nicolaas Tulp (1641)3,4 have attracted claims for priority, reflecting that the history of migraine5,6 and related headaches will continue to fascinate and continually change as long as scholars resurrect long forgotten texts.
Van Swieten published other neurological works including the idea that embolism arising in the heart and great vessels could occlude the arteries of the brain and cause a stroke.7
In the centre of Vienna, the huge Maria Theresien monument towers between the history of art and the natural history museums. The robed figure of van Swieten stands out. Van Swieten8,9 was a student of Herman Boerhaave (1668–1738) in Leiden. Boerhaave, a true intellectual giant, had adopted the clinically founded teachings of Willis and Sydenham and spent his life at Leiden, serving as professor both of botany and medicine.
The Netherlands was predominantly Protestant. That Van Swieten was a Catholic may have influenced his decision in 1745 to accept the Empress Maria Theresa's (1740–80) invitation to be court physician and university professor in Vienna. He had earned the Empress's admiration and she made him her personal physician, awarded him a baronetcy and appointed him director of the Army Medical Services.
Van Swieten (“ Boerhaave's Boswell”) brought Boerhaave's methods to Vienna, reforming and enhancing the university and its medical school. For 30 years, he published and republished his famous Commentaries upon the aphorisms of Herman Boerhaave, originally in Latin, then in Dutch, Spanish, French, German and English (fig 11).). His drastic reforms of the medical faculty10 included the appointment of professors by the Empress, not as before by the university; he instigated rigid governmental supervision of examinations, established a chair of chemistry, compelled delivery of clinical lectures in the hospital and founded a botanical garden. He appointed many distinguished teachers,11 including Anton de Haen (1704–76) and his successor, Maximilian Stoll (1742–88). Under their supervision, Leopold Auenbrugger (1722–1809) invented the technique of percussion,12 although they failed to recognise its value.
Van Swieten made several other advances, notably in public health and he wrote an influential Manual on diseases incident to armies.
He corresponded with Carolus Linnaeus (1707–1778) in Uppsala, on botanical matters from 1745 to 1759. His son, Baron Gottfried van Swieten, became Mozart's patron.
1 The active ingredient of Peruvian bark was quinine.
2 Boerhaave's famous portrait by Cornelis Troost is in the Rijksmuseum, Amsterdam, the Netherlands.
Competing interests: None.